title: Interarm differences in systolic blood pressure and mortality among US army veterans: aetiological associations and risk prediction in the Vietnam Experience Study.
abstract: BACKGROUND
  Differences between the arms in systolic blood pressure (SBP) of ≥10 mmHg have been associated with an increased risk of mortality in patients with hypertensive and chronic renal disease. For the first time, we examined these relationships in a non-clinical population.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Participants were 4419 men (mean age 38.37 years) from the Vietnam Experience Study. Bilateral SBP and diastolic BP (DBP), serum lipids, fasting glucose, erythrocyte sedimentation rate, metabolic syndrome, and ankle brachial index were assessed in 1986.
  
  
  RESULTS
  Ten per cent of men had an interarm difference of ≥10 and 2.4% of ≥15 mmHg. A 15-year follow-up period gave rise to 246 deaths (64 from cardiovascular disease, CVD). Interarm differences of ≥10 mmHg were associated with an elevated risk of all-cause mortality (hazard ratio, HR, 1.49, 95% confidence interval, CI, 1.04-2.14) and CVD mortality (HR 1.93, 95% CI 1.01-3.69). After adjusting for SBP, DBP, lipids, fasting glucose, and erythrocyte sedimentation rate, associations between interarm differences of ≥10 mmHg and all-cause mortality (HR 1.35, 95% CI 0.94-1.95) and CVD mortality (1.62, 95% CI 0.84-3.14) were significantly attenuated.
  
  
  CONCLUSIONS
  In this non-clinical cohort study, interarm differences in SBP were not associated with mortality after accounting for traditional CVD risk factors. Interarm differences might not be valuable as an additional risk factor for mortality in populations with a low risk of CVD.
authors.affiliation: Cardiff University, Cardiff, UK whitej11@cf.ac.uk.
authors.forename: James
authors.initials: J
authors.lastname: White
authors.affiliation: University of Copenhagen, Copenhagen, The Netherlands.
authors.forename: Laust H
authors.initials: LH
authors.lastname: Mortensen
authors.affiliation: University College London, London, UK.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.affiliation: University of Southampton, Southampton, UK.
authors.forename: Catharine R
authors.initials: CR
authors.lastname: Gale
authors.affiliation: University College London, London, UK.
authors.forename: G David
authors.initials: GD
authors.lastname: Batty
mesh_terms: D000328:Adult; D055109:Ankle Brachial Index; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D001799:Blood Sedimentation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*; D008055:Lipids / Q000097:blood; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D034941:Upper Extremity / Q000098:blood supply*; D058014:Veterans Health; D047829:Vietnam Conflict
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids
keywords: Epidemiology; hypertension; risk factors